PROJECT SUMMARY Despite the benefits of using clinical checklists for protocol compliance, only a few have been proven effective in improving patient outcomes. Studies of checklist compliance have also shown that tasks are not necessarily performed when the corresponding items are checked, which poses widespread risks to patient safety. Our long-term goal is to develop a context-adaptive checklist that will be integrated into a computerized decision support for dynamic, safety-critical medical processes such as trauma resuscitation and other types of high-risk clinical settings. The goal of the current proposal is to identify context attributes associated with non-compliant use of a checklist that is administered concurrently with dynamic clinical activities during trauma resuscitation. Our central hypothesis is that context attributes impact the likelihood of checklist compliance. The rationale for this proposal is that improving checklist design to address these contextual factors will improve checklist compliance, task performance and patient outcomes. The central hypothesis will be tested by pursuing two specific aims: 1) identify patient, provider, task and event attributes that are associated with clinical checklist compliance; and 2) determine how task complexity affects the timing and accuracy of interactions with a clinical checklist. Under the first aim, the approach will involve analyzing resuscitation activity logs, video recordings of actual resuscitations, and interaction logs from the digital version of the resuscitation checklist to identify patient, provider, task and event attributes, and to determine their effects on checklist compliance. For the second aim, the approach will focus on analyzing how different task attributes affect checklist compliance. These studies are an essential step toward improving the design of clinical checklists to ensure complete, timely and successful task performance. This project is significant because it studies the relationship of checklist compliance behaviors to actual task performance and task attributes, an aspect of checklist compliance that has received little attention to date. The proposed research is innovative because it represents a substantive departure from the status quo in the checklist compliance research by using a novel digital checklist to obtain objective data about checklist compliance and its relationship to task performance during trauma resuscitation. The results of this research are expected to form the basis for a context-adaptive checklist for supporting real-time decision making of medical teams that improves patient outcomes during trauma resuscitation and other critical care processes.